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Objective  To investigate the impact of tumor necrosis factor inhibitor ( TNF i) treatment and inflammation control on radiographic progression in early ankylosing spondylitis ( AS ) over 4 years.    Methods  We included a total of 215 patients with early  AS  (symptom duration <10 years) treated with  TNF i (the  TNF i group; n = 135) or with nonsteroidal antiinflammatory drugs ( NSAID s) (the control group; n = 80). Two blinded readers assessed radiographic progression using the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ). Inflammation control was inferred from C‐reactive protein ( CRP ) levels time‐averaged between 2 radiologic assessments. Linear mixed modeling was used to estimate  mSASSS  changes over radiographic intervals as well as the impact of clinical factors on outcomes.    Results  The  TNF i group had longer disease duration, a higher baseline  CRP  level, and a higher Bath Ankylosing Spondylitis Disease Activity Index than did controls. The time‐averaged  CRP  level over radiographic intervals was lower with  TNF i treatment than with  NSAID  treatment (mean ±  SD  0.27 ± 0.30 mg/dl versus 0.61 ± 0.68 mg/dl;  P  < 0.001). Overall, mean ±  SD mSASSS  change over the 2‐year interval was 1.30 ± 2.97 units. In the multivariable model adjusted for age, smoking status, baseline  CRP  level, and the presence of syndesmophytes at baseline, the  TNF i group showed less  mSASSS  change over the 2‐year interval (β = −0.90 [95% confidence interval {95%  CI } −1.51, −0.29]). However, when a time‐averaged  CRP  level was additionally included, it significantly influenced the  mSASSS  change (β = 1.02 [95%  CI  0.32, 1.71]), decreasing the estimated group difference (β = −0.52 [95%  CI  −1.17, 0.14]).  NSAID  indices of both groups were not associated with either time‐averaged  CRP  levels or  mSASSS  changes.    Conclusion  Effective suppression of inflammation by  TNF i treatment decreases radiographic progression in early  AS .

arthritis and rheumatology

Impact of Tumor Necrosis Factor Inhibitor Versus Nonsteroidal Antiinflammatory Drug Treatment on Radiographic Progression in Early Ankylosing Spondylitis: Its Relationship to Inflammation Control During Treatment